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Periodontal therapy lowers levels of heart disease inflammation markers

Treating periodontal disease with scaling and root planing combined with a topical antibiotic gel can significantly lower the levels of two inflammatory proteins associated with a heightened risk of heart disease, scientists from the State University of New York at Buffalo report.

Blood drawn from 102 subjects with periodontal disease showed elevated levels of both C-reactive protein and fibrinogen, proteins associated with increased risk for heart disease and blood clotting. All of the subjects were free of other conditions that could cause elevated levels of the proteins.

Scientists from the UB School of Dentistry's Department of Oral Biology divided the subjects into two groups to determine if periodontal therapy would be effective in lowering the levels of the heart disease markers. One group received scaling and root planing treatment while the second group received treatment with the topical antibiotic Atridox followed by scaling and root planing.

Based on a treatment regimen at three, six and nine months and blood samples taken at six weeks and at three, six, nine and 12 months, repeated periodontal treatment resulted in a significant reduction in the systemic levels of the inflammation markers, the UB scientists said.

"People who have high levels of CRP in their blood are at high risk of heart disease," Dr. Sara Grossi, senior author of the study, said. "Our results showed that in people who had elevated levels of CRP at baseline, removal of dental plaque bacteria by scaling or scaling combined with topical antibiotics produced a statistically significant reduction, bringing CRP levels close to the low-risk level."

"Both treatments also significantly reduced levels of fibrinogen in patients with elevated fibrinogen levels," she added.

The research was supported by grants from the U.S. Public Health Service, National Institutes of Health and Atrix Laboratories Inc.

Periodontal disease and cardiovascular disease - Epidemiology and possible mechanisms

Abstract

Background: Many early epidemiologic studies reported an association between periodontal disease and cardiovascular disease. However, other studies found no association or
nonsignificant trends. This report summarizes the evidence from epidemiologic studies and studies that focused on potential contributing mechanisms to provide a more complete picture of the association between periodontal and heart disease.

Types of Studies Reviewed: The authors summarize the longitudinal studies reported to date, because they represent the highest level of evidence available regarding the connection between periodontal disease and heart disease. The authors also review many of the case-control and cross-sectional studies published, as well as findings from clinical, animal and basic laboratory studies.

Results: The evidence suggests a moderate association—but not a causal relationship between periodontal disease and heart disease. Results of some case-control studies indicate that subgingival periodontal pathogenic infection may be associated with myocardial infarction. Basic laboratory studies point to the biological plausibility of this association, since oral bacteria have been found in carotid atheromas and some oral bacteria may be associated with platelet aggregation, an event important for thrombosis. Animal studies have shown that atheroma formation can be enhanced by exposure to periodontal pathogens.

Conclusions: The accumulation of epidemiologic, in vitro, clinical and animal evidence suggests that periodontal infection may be acontributing risk factor for heart disease. However, legitimate concerns have arisen about the nature of this relationship. These are early investigations. Since even a moderate risk contributed by periodontal disease to heart disease could contribute to significant morbidity and mortality, it is imperative that further studies be conducted to evaluate this relationship. One particularly important study to be carried out is the investigation of a possible clinically meaningful reduction in heart disease resulting from the prevention or treatment of periodontal disease.

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